CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 834 525.25 19434.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 575 567.75 21006.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1134 2741.75 101426.25 36.99
Subtotal (Total Children Is Unduplicated) 1681 3834.75 141867.25 37.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 4 7.50 375.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.00 450.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 12.50 937.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.00 333.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 21.00 1575.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 19.50 1082.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 32.00 2400.00 75.00
Subtotal (Total Children Is Unduplicated) 47 105.50 7202.75 68.27
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 17.00 850.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 48.00 2400.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 1980.00 990.00 0.50
Subtotal (Total Children Is Unduplicated) 20 2046.00 4265.00 2.08
----------------------------------------------------------------------------------------------------------------
Total 5986.25 153335.00 25.61
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1681
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 132 104.00 3848.00 0.00
H 10 11.50 794.25 0.00
T 137 1601.00 8872.75 8872.75
7048 4269.75 139820.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7327 5986.25 153335.00 8872.75